IMC/FM/EMED Rheum/Endo/Renal Flashcards
Define RA
How does this present on exam
What two syndromes can be seen w/ this Dz
Chronic autoimmune inflammatory dz w/ persistent symmetric polyarthritis
AM stiffness improving throughout the day affecting DIP and PIP
Felty’s: RA+splenomegaly and repeat infection
Caplan: pneumoconiosis and RA
What lab result is most specific for Dx RA
How is RA Tx
What drug can be used for Tx of RA and Ankylosing but w/ ? s/e
Anti-CCP
Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide; diarrhea
What will be seen in lab results of OA
What issue develops from OA in the knee
What are the 3 meds that can cause lupus
Normal ESR/CRP
Bakers Cyst
Procainamide
Isoniazid
Quinidine
SLE is a systemic autoimmune d/o characterized by ? triad
? is the best, initial test for Dx SLE
What f/u test is used for confirmation that is 100% specific
Butterfly rash, spares nasolabial folds
Joint pain
Fever
ANA
dsDNA
AntiSM
? lab result in an SLE work up indicates Pt is at higher risk for thrombosis
What result is associated w/ false positives
Pregnant females with the above result are at risk for miscarriages if they also have ?
Antiphospholipid Ab syndrome
Anticardiolipin Ab
B2 glycoprotien 1 Ab
What two biomarkers in an SLE work up indicate a higher risk for neonatal lupus erythematosus
? result has a high sensitivity for drug induced lups
Anti-Ro and Anti-La
Antihistone Ab
SLE is Dx by four or more of ? mnemonic
RASHNIA-4 Rneal d/o Arthralgia Serositis Heme d/o Neuro d/o Imm derangemetns ANA
4 types of rash: Malar discoid Photosensitivity Mucosal involvement
How is SLE Tx
Define CREST Syndrome
What condition is this syndrome associated w/?
Hydroxychloroquine Acetaminophen NSAIDs Sun protection Methotrex/Cychophos
Calcinosis Raynauds Esophageal dysfunction Sclerodactyly Telangiectasis
Scleroderms
How is Scleroderma Dx
How is it Tx
What medication is reserved for resistant cases
Anti-centromere: limited CREST, better prognosis
Anti-SCL 70: diffuse dz w/ multiple organ involvement
Methotrexate
Mycophenolate
Cychlophosphamide
How is Raynauds in Scleroderma Tx
How is P-HTN Tx in scleroderma
How is the renal invovlement Tx in scleroderma
CCBs and prostacyclin
Ambrisenten
Tadalafil
ACEI: Captopril drug of choice during renal crisis
Ankylosing Spondylitis is also associated w/ ? Dxs
? is the gold standard method to eval and support a Dx
How is this condition Tx
Psoriasis
Anterior uveitis
IBDz
Regurg, aortic
X-ray
PT, NSAIDs
Refractory:
a-TNFs: Etanercept, Infliximab
Joint Sxs: Sulfasalzine, Methotrexate
? is the classic triad of Reiters Syndrome
What type of infections is this MC seen w/
How is it Dx
Conjunctivitis
Urethritis
Oligoarthritis
G/C Campylobacter Salmonella Yersinia Shigella
HLA-B27
Synovial fluid: aseptic w/ negative bacterial cultures
How is Reiter’s Tx
Define Gout
What causes these attacks/flares
NSAIDs
ABX
Methotrexate
Etanercept/Infliximab
Uric acid accumulation in joints/tissue
Purine rich food
What meds can cause/worsen gout attacks
What is the name of the attach in the great toe
Define Pseudogout
Thzd/Loops ACEI Pyrazinamide ASA ARBS men >30 and postmenopause women
Podagra
Ca pyrophosphate crystals accumulate in tissues
What joints does Pseudogout affect most often
What will be seen on x-rays of pseudogout
What uric acid levels helps confirm a Dx of tou
Knees, Wrist
Chondrocalcinosis- linear radiodensities
> 7.5
What does gout look like under microscope
What does psuedogout look like under microscope
Neg birefringent needle crystals
Pos biregringent rhomboids
What is done for acute management of gout
What drug is used for 2nd line Tx
What med is used for no response to any of the above
What drug needs to be avoided
NSAIDs-
Naprosyn, Indomethacin
Colchicine
Prednisone, possible first line in elderly Pts
ASA- inc uric acid levels
When is chronic gout management considered
What is used for management
2 or more acute gout flares/year
Allopurinol- dec production
Probenecid (Uricosuric drug)- inc urine excretion
NSAID/Colchicine x 3mon
How is pseudogout Tx
What is used for prophylaxis
Define Polymyositis
First line: CCS
NSAIDs
Colchicine
Chronic, idiopathic inflammatory dz of muscle causing symmetric, proximal weakness/pain
What would be seen on PE in Pts w/ Polymyositis
What parts of the body are MC affected
How is Polymyositis different from Dermatomyositis and Polymyalgia Rheumatica
Early fatigue
Inability to rise from seated
Shoulders, Hips
Derm: skin changes
PR: lack of joint pain
Polymyositis will have inc muscle enzymes
Define Dermatomyositis
What differentiators may be seen on exam
Autoimmune myopathy w/ symmetric proximal weakness AND cutaneous findings
Gottrons: raised purple, scaling plaques on bone prominences
Shawl/V-sign: pink rash on neck/trunk
Heliotrope rash: purple/red rash around eyes/on lids
What would be seen on muscle biopsy results in Dermatomyositis Pts
What serology result is specific for Dermatomyositis
What marker is specific for interstitial lung fibrosis
Endomysial inflammation
Anti-Mi-2 Ab
Anti-Jo 1 Ab
How is Polymyositis/Dermatomyositis Tx
Fibromyalgia is associated w/ ? three issues
How is it Tx
Suppress w/ CCS
Long term Polymyositis management w/ Methotrexate
RA
Apnea
Hypothyroid
TCAs
Swimming
Pregablain
What part of the body is attacked during Sjogrens
How is it Dx
What test can be done in office for Dx
Exocrine glands
ANA
Anti-SS A (anti-RO) and,
Anti SS B (anti-La)
Schirmers tear test: pos if <5mm lacrimation in 5min
How is Sjogrens Tx
What is the Rule of 50 for GCA
What branches of the carotid artery are affected by GCA
Tears
Pilocarpine- cholinergic
for xerostomia
Cevimeline
Age >50
ESR >50
Steroids >50
Posterior Ciliary
Occipital
Ophthalmic
Temporal
Define Polymylagia Rheumatica
This condition is heavily associated w/ ? other d/o
What do Pts present w/ as c/c
Inflammatory condition causing synovitis, bursitis and tenosynovitis
GCA
Morning stiffness and joint swelling w/ normal strength
How is Polymyalgia Rehumatica managed
Define Polyarteritis Nodosa
Small percentage of Pts will have ? underlying d/o
CCS
Methotrexate
Vasculitis of med/small arteries
Hep B/C
Two abnormal c/c making Polyarteritis Nodosa a possible dx
How is a Dx confirmed
How is this condition Tx and what is used for refractory cases
New foot/wrist drop
Rapid developing HTN
Biopsy- necrotizing arteries
Ateriography- aneurysms in small/med arteries
CCS
Refractory= Cyclophos
+Hep B: plasmapheresis
? is the MCC of hypothyroidism
What will be seen on lab results
How is this form of thyroid d/o Dx
Hashimotos
High TSH, low FT4
Anti-TOP Abs
? type of anemia is commonly seen in hypothyroidism
What other lab result is usually high too
How is this Tx
Normo/Normo
Serum cholesterol
Thyroxine/Synthroid
? is the MCC of hyperthyroidism
What will lab results show
How is this Tx
Graves dz
Low TSH, high T3 and FT4 (graves- only T3 is elevated)
Methimazole- mild cases
PTU- including pregnancy
Define Thyroid Storm
How is hyperthyroidism Dx
How are cardiac Sxs of hyperthyroidism Tx
Hyperthyroidism from uncontrolled/un-Dx hyperthyroidism
Anti-thyrotropin Abs (TSHR-Ab)= Graves
Atenolol
How is Graves Dz Tx
What are 5 etiologies of thyroiditis
Methimazole
PTU
Hashimotos Post-Partum Subacute (Quervains) Drug induced Infection w/ bacteria
? is the MCC of thyroid pain
What is the etiology of this MC
What path does this follow and w/ ? lab result
Subacute thyroiditis (Quervains)
Post infectious/viral
Hyper to hypo-thyroid;
Inc ESR
Two common meds that cause thyroiditis
Infectious thyroiditis are usually d/t ? microbes
Painful thyroiditis usually means ?
Lithium
Amiodarone
Staph/Strep
Trauma
Radiation
Infection
Painful subacute
How is Subacute/Postpartum thyroiditis Tx
? is the MC RF for thyroid Ca
? is the MC type
BBs, ASA
Radiation
Papillary
? is the MC benign thyroid nodule
Thyroid nodules must be bigger than ? size to be palpable
What are the RFs for thyroid Ca
Thyroid adenoma
> 1cm diameter
FamHx
Age >65/<20
Radiation
How are thyroid Ca Dx
What imaging results are suspicious for Ca
How to tell if thyroid nodules are malignant or not
US
>1cm- biopsy
Calcifications Hypoechogenicity Solid Irregular margins Chaotic vasculature More tall than wide
Thyroid uptake:
Ca- cold, no uptake; next step= FNA
Benign- hot, will uptake
How is thryoid Ca Tx
What Tx step is different for ? type of Ca
What does hyperparathyroidism cause
Thyroidectomy w/ chemo
External beam radiation- anaplastic Ca
Inc PTH= Inc Ca;
Ca >12= Sxs
What causes Primary and Secondary Hyperparathyroidism
What saying goes w/ the presentation of hyperparathyroidism
What would be seen in UA results
P: PTH secreting parathyroid adenoma
S: CKDz
Bone pain
Stone, kidney
Groan, ab cramps
Psychic depression, irritability, psychosis
Hyperphosphate
HyperCa
How is hyperparathyroidism Tx
How can the hyperCa be Tx
What is used for Tx if osteroporosis is present
Ectomy
Furosemide
Calcitonin
Bisphosphonates
What are the two MCC of hypoparathyroidism
What two PE findings suggest this Dx
What is seen on EKG
Surgical damage
Autoimmune destruction
Trousseaus: carpal
Inc DTRs
Chvosteks: facial
Prolonged QTc
How is hypoparathyroidism Tx immediately
What is done if tetany is present
What is done for long term management
Vit D, Ca
Secure airway
IV Ca gluconate
Recombinant PTH
? bone Ca is most associated w/ Paget’s Dz
Define Paget’s Dz
? infection can cause this dz
Osterosarcoma (Paget’s Sarcoma)
Bone remodeling d/o leading to less compact/weaker bones
Measles
What parts of the body are MC involved w/ Paget’s Dz
What PE finding can be seen in these areas
What non Ortho issue can PTs have
Skull
Lumbar
Pelvis
Femur
Excessively warm d/t inc vasculature
Deafness
How is Paget’s Dz Dx
How is this condition Tx
Define DMT1
Inc ALP levels
CXR- lytic lesions, thickened cortices
Bisphosphonates
Calcitonin
Autoimmune Abs against B-cells
Define Dawn Phenomenon
Define Somogyi effect
How is each one corrected
Normal glucose until early AM increase d/t insuline sensitivity/nightly surge of regulatory hormones
Nocturnal hypoglycemia followed by hyperglycemia rebound d/t GH surge
D: inc bedtime insulin
S: dec bedtime insulin dose
? type of fluid should be used in the Tx of DKA
What lab results Dx DMT1
How are all DMT1 Tx
NS
Fasting >125
A1c 6.5%/>
Random >200 w/ Sxs
Insulin w/
Basal/pre-meal
A1c rechecks q3mon
When does ASA become part of DMT1 Tx
What vaccinations are needed
Men >50y/o or
Women >60y/o w/ one CVD RF:
Hyper-tension/lipid or albuminuria
Tdap
Annual flu
PCV-13
Pneumococcal
Onset, Peak and Duration of insulin
Novolog/Apidra/Humalog:
10-15m 60-90m 4-5hrs
Regular:
30-60m 2-4hr 5-8hrs
NPH
1-3h 5-8hrs 12-18hrs
Levemir
90min no peak 12-24hrs
Lantus
90min no peak 24hrs
Define Gynecomastia
Define Pseudogynecomastia
What is the MCC in infants/boys
Enlarged breast tissue
Appearance of enlarged breast in obese Pts
Physiologic gynecomastia
What is the MCC of gynecomastia in men
What labs are ordered when onset is painful/sudden w/out drugs or pathological cause
How is Osteoporosis Dx
Persistent pubertal
Idiopathic
Drugs: spironolactone, anabolics, antiandrogens
TSH FSH T Estradiol hCG
DEXA scan
Confirmed fragility Fx
What do T-scores mean
Directions for use of medications during Tx
What adverse outcome can occur
Porosis: -2.5/<
Penia: -1 - -2.4
Take on empty stomach w/ 8oz of water, remain upright x 30min
Jaw osteonecrosis
How is osteoporosis Tx
What med is used in Pts w/ very high risks for Fxs
What other time is the above med used
Alendronate
Risedronate
Teriparatide- recombinant PTH (T-score -3.5 or less
Pts continue to Fx while on bisphosphonates
Define Primary Adrenal Insufficiency
What causes secondary adrenal insufficiency
What infection can cause Primary Insufficiency
Dz in adrenal gland causing dec cortisol secretions
Exogenous steroid- MC
Pituitary adenoma
TB
What meds can cause Primary Adrenal Insufficiency
How is Adrenal Insufficiency Dx
What results mean Dx
Phenytoin
Rifampin
Ketoconazole
Barbituates
8AM serum cortisol and ACTH
High ACTH, low cortisol= primary
Low ACTH, low cortisol- secondary
How is a Dx of Adrenal Insufficiency confirmed and differentiated between Primary/Secondary
How is Primary/Secondary Tx
Cosynotropin Stim test-
Primary: high ACTH, low cortisol
Secondary: little/no increase of cortisol after ATCH is given
Addison:
Hydrocortisone
Fludrocortisone
Secondary: pituitary adenoma resection
Define Pheos
What other Dxs are these associated w/?
What are the 5 Ps of Pheo Sxs
Catecholamine secreting adrenal tumor releasing Epi/NorEpi
NF-1
MEN 2A/@b
Von Hippel Dz
Pressure, HTN Pain, HA Perspiration Palpitations Pallor
How are Pheos Dx
How are these Tx
What has to be done prior to Tx
24hr catecholamine UA for metanephrine/canillylmandelic acid
Adrenalectomy
A-blockade: phenoxybenzamine or,
Phentolamine
Define Cushings Syndrome
Define Cushings Dz
What will be seen in lab results of Syndrome
Inc cortisol Sxs
Inc cortisol d/t excess ACTH, usually pitutary adenoma
Inc cortisol/BP
Dec K
Why do Cushing’s Dz Pts gain weight
How is Cushings Syndrome Dx
Cortisol stimulates fat/carb metabolism
Insulin released
Increased appetitie
Dexamethasone suppression test and,
24hr urine cortisol- gold standard
When working up Cushings Syndrome, what is the next step after a positive low dose dexamethasone test
What are results interpretted
High dose dexamethasone suppression test
Dec ACTH: adrenal tumor
Inc/Norm ACTH: ectopic ACTH producing tumor
Cushings Syndrome is Tx by removing ectopic/adrenal tumor, what is done for PTs ineligible for surgery
What is the difference between gigantism and acromegaly
How is Acromegaly Dx
Ketoconazole
Giant: GH secretion in childhood prior to epiphyses closing
Acro: GF secretion starts in adulthood
Serum IG-F1
How is Acromegaly Tx if surgical resection is not possible
Define Diabetes Insipidus
What are the two types
Octerotide/Lanreotide to suppress GH secretion
Deficiency/resistance to vasopressin
Central: MC; no ADH production
Nephrogenic: insensitivity to ADH
What drugs can cause Nephrogenic Diabetes Insipidus
What electrolyte abnormalities can cause DI
Lithium
Amphoterrible
HyperCa
HypoK
How is Diabetes Insipidus Dx w/ lab results
What is the simplest and most reliable test to Dx
How is a Dx differentiated from Central and Nephrogenic
High serum osmolality
Low urine osmolality
Water deprivation test: DI continues to produce diluted urine
Desmopressin stimulation test:
Central: dec urine output (no ADH production)
Nephro: continues urine production (ADH resistance)
How is Central Diabetes Insipidus Tx
How is Nephrogenic Diabetes Insipidus Tx
Desmopressin/DDAVP- monitor E+
Na/Protein restrictions
Chronic: Hydrochlorothiazide, Amiloride
Acute in FamMed/ER: Indomethacine
What are the four types of stones seen in Nephrolithiasis
Which ones are radiolucent and radiopaque
Ca Oxalate- MC; grapefruit inc production
Struvite: chronit UTI d/t Klebsiella, Proteus
Uric acid- acidic urine
Cystine- genetic difficiency;
Paque: oxalate, struvite
Lucent: cystine, uric acid
How is Nephro/Urolithiasis Dx
How are these conditions Tx
What are the indications to admit
CT w/out contrast
Morphine/Ketoralac
Hydration
ABX if +UTI
Flomax- A-blocker; stones 5-10mm
Pain uncontrolled w/ PO meds
Anuria
Renal Colic and UTI/Fever
When are elective lithotripsys considered for Nephro/Urolithiasis Tx
? is the MC method of lithotripsy
What is the next step if lithotripsy fails to Tx
5-10mm
> 10mm- stent of nephrostomy if renal function jeopardized
Extracorporeal- best for stones <5mm, <2cm
Percutaneous nephrolithotomy- >2cm
Define Cystitis
What two findings help solidify this Dx
What is the first and second MC microbe to cause this type of infection
Bladder infection w/ dysuria and w/out d/c
Afebrile
No flank pain
1st: E Coli
2nd: Enterococcus/Saprophyticus
What is the MCC of recurrent cystitis in men
How is Cystitis Dx
How are they Tx
What is used for pain relief
Chronic bacterial prostatitis
Culture- gold standard
Dipstick: nitrite, leukocyte esterase
TMP-SMX
Nitrofurantoin
Fluoroquinolone
Fosfomycin
Phenazopyridine
ASx bacteriuria in geriatrics requires no Tx unless ?
How are UTIs Tx in pregnancy
How are postcoital UTIs Tx
DM
Sructural abnormals
Nitrofurantoin
Cephalexin
TMP-SMX
Cephalexin
How are UTIs in Peds Tx
How does Pyelonephritis present
What microbe is the MCC
Low risk renal involvement: Keflex
High risk for renal involvement: Cefuroxime
Fever
CVA tenderness
N/V
E Coli
What UA result is pathognomonic for pyelonephritis
What other Dx is this pathognemonic for
How is this Tx
WBC casts
Interstitial nephritis
Cipro/Levo/Cephalexin
What is used for Tx pyelonephritis in admitted Pts
How are these infections Tx in pregnant Pts
What is the most important RF for ED
Ceftriaxone
Admit,
IV Ceftriaxone
Artherosclerosis of cavernous arteries d/ smoking/DM
Priapism is associated w/ ? 3 etiologies
How is ED Tx
What is the MOA
Trazodone
Coaine
Sickle cell dz
Phosphodiesterase inhibitors
Inc cGMP to increase NO release
What ED Txs need to be taken w/ or w/out food
Which one has the longest effect of 24-36hrs
How are med induced priapisms Tx
Sildenafil- w/
Vardenafil- w/out
Tadalafil
Stairs
Sudafed
What are the 5 types of incontinence
Mixed- MC
Urge- detrusor over activity
Dx: urodynamic study
Functional- physical/mentally disabled
Overflow- impaired detrusor contractility
Stress- weak pelvic floor; post-pregnancy
? is the only mandatory lab needed for Peds w/ enuresis
Define Nocturnal Enuresis
UA
Involuntary sleeping urination after 5y/o
How is incontinence Tx depending on etiology
Mixed- lifestyle mod and floor exercises
Urge- training, Oxybutynin, Imipramine- TCA
Functional- schedule
Overflow- self-cath, Bethanechol, -zosin)
Stress- kegels, vaginal estrogen, pessary, mid-urethral sling surgery
Epididymitis is characterized by ? triad
How is the microbe etiology differed by age
What PE finding is classic for this Dx
Dysuria
Unilateral pain, posterior testis
Swelling
<35: G/C
>35: EColi
Prehns- relief w/ elevation
How is Epididymitis Tx
How is this Tx in Pts that practice insertive anal sex
Define Orchitis
<35y/o: Ceftriaxone and Doxy >35y/o: Levoflox or, TMP-SMX
Ceftriaxone and
Levofloxacine
Ascending bacterial infection from urinary tract to testes
How is Orchitis Dx
How is this Tx
UA w/ culture:
Pyuria, Bacteriuria
<35y/o:
Ceftriax and Doxy or
Azithromycin
>35 w/ no STI DDx: Levofloxacin (x21 days if w/ prostatitis)
How does acute bacterial prostatitis present on DRE
What is the MC form of prostatitis
How does the MC present on DRE
Boggy, warm and tender
Chronic
Enlarged, non-tender
How are acute/chronic prostatitis Dx
What microbe will usually be isolated from prostate fluids
How is prostatitis Tx
Acute:
UA w/ WBC, +cultures
Chronic- negative cultures
<35y/o: Ceftriax and Doxy >35y/o/ chronic: Fluroquinolones or Bactrim IV Levo/Cipro
Pts w/ BPH need to avoid ? three classes of drugs
How does BPH present on DRE
What PSA result is beneficial for Dx
Anticholinergic
Sympathomimetics
Opioids
Enlarged, firm/rubbery
Normal: <4
BPH/Ca/Prostatitis: >4
How is BPH Tx
How is this Tx if Pt is refractory to meds
How does prostate Ca present on DRE
Tamsulosin
5-a reductase- dec size: Finasteride/Dutasteride
TURP; transurethral resection of prostate
Hard, nodular and asymmetric
What are the two RFs for prostate Ca
What is the Dx work up
When is screening done
Age
FamHx
PSA >4: US w/ needle biopsy
PSA >10: bone scan
> 50y/o
40y/o if first degree FamHx/AfAm
How is Prostate Ca Tx
How is this Tx if mets is present
How is this Tx if no mets are present
What is used for monitoring
Prostatectomy
Ieuprolide
Castration
PSA <0.1
? is the MC type of bladder Ca
What is the ‘classic’ presentation
How is this definitively Dx
Transitional cell Ca
Painless hematuria in smoker
Cystoscopy w/ biopsy
How is bladder Ca Tx
What is the classic triad for renal cell carcinoma
What is the MC type of renal cell carcinoma and w/ ? RF
Endoscopic resection w/ cystoscopy q3mon
Flank pain
Hematuria
Mass
Clear cell; smoking
What are the first tests for Dx renal cell carcinoma
How is this Tx
How does testicular cancer present
Abdominal CT/US
Radical Nephrectomy
Firm, painless mass in 15-40y/o
? is the MC type of testicular Ca
What are the two types of this MC
What is the RF for this type of Ca
Germ cell tumor
Seminoma
Non-seminomatous
Cryptorchidism
How is testicular Ca Dx
What are the 3 most likely locations for mets
What tumor markers are used
What non-tumor marker is also used
US
Belly
Brain
Lung
AFP- NSGCT only
HCH- both seminoma and NSGCT
LDH-
Higher seminoma burden
NSGCT recurrence
How is testicular Ca Tx
? is the most convenient marker for assessing acute RF
What are the 3 mechanisms of acute RF
Orchiectomy
Seminoma- radiosensitive
NSGCT- radioresistant
Creatinine
Pre: perfusion
Renal: glomerular, tubular, interstitial
Post: obstructive
What do UA results look like in pre-renal acute RF
What do UA results look like in renal acute RF
Spec Grav: >1.030
BUN/Cr >20
Osmolality >500
FENA <1
Spec Grav <1.010
BUN/CR <10
Osmolality <300
FENA >1
During renal failure work ups, what doe the following mean
RBC casts
WBC casts
Muddy casts
Hyaline casts
Waxy casts
Inc osmolality FENA >2%
RBC: glomerulonephritis
WBC: pyelonephritis
Muddy: tubular necrosis
Hyaline: normal
Waxy: chronic renal dz
O-FENA: tubular necrosis
What are the 3 MC causes of acute renal failure in order
Tubular necrosis
Interstitial nephriti
Glomerulonephritis
What causes acute tubular necrosis
What is the MCC
What does the FENA look like
Kidney ischemia
Toxins
Pre-renal fialure
> 2%
What causes Interstitial Nephritis
What will be seen on UA results
How is it Tx
Immune mediated response
WBC casts,
Hematuria
Eosinophils
D/c offender
CCS
Dialysis
What are the 3 etiologies of Glomerulonephritis
What will be seen on UA results
What criteria is needed for Dx of CKDz
IGA nephropathy (bergers dz)
Post-infectious
Membranoproliferative
Hematuria
RBC casts
eGFR <60mL x 3mon or, Albuminuria >30mg/day Proteinuria/Cr >0.2 Hematuria Structural abnormals
? is the MCC of CKDz
How is CKDz staged
What stag is considered “symptomatic stage”
DM
1: normal GFR w/ persistent albuminuria/structural dz
2: GFR 60-89
3: GFR 30-59
4: GFR 15-29
5: GFR <15
Stage 4
Pts w/ CKDz need to avoid ? compound
? UA result is a specific finding to CKDz
? marker is used for kidney damage w/ ? appearing early in dz
Mg
Broad waxy casts
Proteinuria;
Microalbuminuria
How is CKDz Tx
What is the JNC-8 BP goal
What is the A1c goal range
What vaccine do Pts need
ACEI/ARB
<140/90
11-12g
Pneumococcal
Define Glomerulonephritis
There are two types and are based on ?
Inflammed glomeruli causing protein/RBC leakage into urine d/t immune response
24hr protein:
Nephritis 1-3.5g/day
Nephrotic >3.5g/day
What is the classic presentation of Nephritic Syndrome
? infection can cause this syndrome
How is this post-infectious etiology Dx
HTN
Edema
RBC casts
Proteinuria <3.5g/day
Group A strep
ASO titer w/ low complement
? is the MCC of anute glomerulonephritis worldwide
How do Pts present
How is this Dx
IgA Nephropathy- Berger Dz
Gross hematuria
Flank pain
URI
IgA deposits in mesangium
Define Alports Syndrome
What non-renal exam needs to be done
How is this syndrome Dx
Isolated, persistent hematuria in Peds w/ RF and hearing loss
Ophth exam: anterior lenticonus
Complement
What causes Membranoproliferative Glomerulonephritis
How is this form Dx
What lab result is Dx of Rapidly Progressing Glomerulonephritis
SLE
Viral hepatitis C
Low C4, C4
Crescent formation of biopsy d/t fibrin/plasma proteins
Rapidly Progressing Glomerulonephritis is AKA ?
? type of Abs are found
How is it Tx
Goodpastures
Anti-GBM
Steroids
Plasmapheresis
Cyclophosphamide
What type of Abs are seen in Rapidly Progressing Glomerulonephritis induced vasculitis
This is AKA ?
Glomerulonephritis as a group usually has ? decreased lab result and needs / for Dx
ANCA Abs
Wegners
Dec C3,
Renal biopsy- gold standard
How is Glomerulonephritis Tx
This Tx is changed to ? in post-strep nephritis
How is the IgA nephropathy Tx
Enalapril/Losartan
Nifedipine
CCS
What makes the cysts in PCKDz
? other life threatening c/c can these Pts present w/
What cardiac abnormalities can these Pts have
Epithelial cells from renal tubules
Worst HA d/t brain aneurysms
MVP, LVH
How is PCKDz Dx
What genetic studies are needed
How are these Pts managed until transplant is possible
US
PKD-1 and 2
ACE/ARB
? is the MC E+ d/o
What causes this MC to occur
What are the 4 types
HypoNa
Hypotonic fluids
HypoVol, HypoNa- volume contracted
HyperVol, HypoNa- volume expanded
SIADH- volume expands w/out edema
HypoNa w/ euvolemia
How is HypoNa Tx
How fast is Tx limited to
If severely hypoNa, don’t Tx faster than ?
0.9% NS
Loop diuretics
No fast 0.5mEq/L/hr
3% NS; Don’t exceed 10mEq over 24hrs to avoid demyelination syndrome
What lab result suggest HyperNa
How is this Tx
What happens if Tx is too fast
BUN/CR >20:1
D5W
Cerebral edema
Pontine herniation
HyperK can be seen in ? stage CKDz
How is this Tx
When is HypoK seen
Stage 5
Peaked T-wave
Prolonged QRS
Sodium bicarb
Insulin
Glucose
Diuretic OD
Cushing syndrome
What does HypoK look like on EKG
What is avoided while replacing K
MCC of hypo/hyperCa
Flat/Invert T wave
U-waves
Destrose- stimulates insulin and will cause K shift into cells
Hypo: Hypoparathyroidism
Hyper: hyperparathyroidism
How does HypoCa look on EKG
How is it Tx
How is HyperCa Tx
Prolonged QT
Ca gluconate
Ca chloride
NS and furosemide
How does HypoMg present
How is this Tx
How is HyperMg Tx
Weak
Hyper-reflex
Widened EKG
Acute: IV Mg
Chronic: PO Mg
Isotonic saline
Loop diuretics
What is the average value rule for Acid-Base d/os
What is the 3 step approach to assessing acid/base d/ox
DDx for metabolic acidosis
24/7 40/40
Bicarb: 24
pH 7.40
Co2- 40
pH PCO2 Bicarb
Anion gap: Na - (Cl+BiCarb)= 10-16 >16: MUDPILES Methanol Uremia DKA Paraldehyde Infection Lactic acidosis Ethylene glycol Salicylates
metabolic Acidosis w/ low anion gap suggests ?
Posterior pituitary AKA ?
Anterior pituitary AKA ?
Hormones stored by posterior pituitary
Diarrhea
Pancreatic/biliary drainage
Renal tubular acidosis
Neurohypophysis
Adenohypophysis
ADH
Oxytocin
What receptors does ADH stimulate
What stimulates ADH release
V1- vessels, smooth muscle
V2- collecting duct causing water retention via aquaporin 2 channels
Osmoreceptors in hypothalamus- Inc serum osmolality
Baroreceptors in arteries/atria- dec in pressure/volume
4 etiologies of Central DI
3 etiologies of Nephrogenic DI
How does DI present to clinic
Surgery, brain
Infection: Syphilis Encephalitis TB
Trauma/inflammation/tumor
Sheehan syndrome- pituitary infarct
Meds
HypoK, HyperCa
Renal Dz
> 2L urine/day w/ low SpecGrav <1.006
How is Central DI isolated on tests
How is Nephrogenic DI Dx
(No ADH production)- Measure 12hr urine output Desmopressin acetate given Measure 12hr urine output \+ Central DI= dec thirst/output, inc urine osmolality
Serum vasopressin measured during fluid restriction, += elevated
What hormones are produced in anterior pituitary
The hormones located here are responsible for ? 3 functions
First line therapy for anterior pituitary adenomas is ? w/ ? exception
FSH LH ACTH GH
PRL Endorphins TSH
Melanocyte stimulating hormone
Metabolism
Sexual development
Growth
Surgery;
Prolactinomas- medical therapy
? drugs suppress prolactin secretion
? drugs suppress GH secretion
Stopped
Dopamine agonists
Somatostatin analogues
Slide 30, Deck 2
